Chapter 5: Structural Competency: Moving Beyond Cultural Competency in the Mental Health System

The focus of this chapter is the many limitations of cultural competency approaches for addressing mental illness in racially and culturally diverse societies. Instead, I will argue for the importance of moving beyond cultural competency to adopt structural competency approaches. For example, I point out that cultural competency approaches often train health professionals to undermine or ignore how diagnoses convey profound racial and cultural meanings and blame the individual for their problems rather than systems of oppression.

Structural competency approaches, on the other hand, are better able to recognise and address the complex ways that structural inequalities such as racism, police brutality, unemployment, rising income inequality, decaying infrastructure, educational underachievement, poor food-distribution networks, and economic factors lead to worse health and mental health outcomes in Black and other marginalised communities. As I point out in this chapter, structural competency pushes beyond cultural competency approaches that have tended to focus primarily on cultural differences, the behaviours of patients, and the interactions between patients and health professionals. Instead, structural competency is more focussed on interrogating and critiquing ‘common-sense’ knowledge in the health and mental health systems, revealing the gaps in these systems and training health and mental health professionals to provide services that more effectively grapple with the structural inequities and upstream factors that impact health and mental health in marginalised communities.